Lena Savoie
Post-Traumatic Stress Disorder (PTSD) and Alcohol Use Disorder (AUD) have been linked for over 40 years, with individuals diagnosed with PTSD experiencing AUD to a greater degree than those without. This harmful use of alcohol as a coping mechanism to self-medicate and relieve symptoms of PTSD can lead to alcohol dependence and worsen PTSD symptoms, creating a vicious cycle. This relationship between PTSD and AUD is especially prevalent among veterans, with 63% of veterans diagnosed with AUD meeting the criteria for PTSD, and vice versa. Understanding this link between the two disorders is crucial to providing effective treatment and support for those affected.
| Characteristics | Values |
|---|---|
| Individuals with PTSD use alcohol | To a greater degree than those without PTSD |
| PTSD and AUD | Are conditional disorders |
| PTSD diagnosis | Experiencing a qualifying traumatic event and three other clusters of symptoms: re-experiencing the event, emotional numbing and avoidance of cues and reminders of the event, and hyperarousal |
| PTSD and AUD | Are common comorbidities |
| PTSD and AUD | Are more prevalent in veterans |
| PTSD and AUD | Are more prevalent in women |
| Alcohol | May provide temporary relief from intrusive thoughts |
| Alcohol | May increase the likelihood of experiencing further traumatic experiences |
| Alcohol | Alters the brain and central nervous system, preventing proper responses to coping with anxiety, depression, and other symptoms |
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What You'll Learn
PTSD and AUD comorbidity
PTSD is a mental health condition that can occur after a person has experienced a significant traumatic event. Symptoms of PTSD include feelings of helplessness, aggression, depression, anxiety, and even suicidal thoughts. People with PTSD may also experience hallucinations, nightmares, and flashbacks. To cope with these symptoms, many turn to alcohol, which can provide temporary relief from intrusive thoughts. However, as the effects of alcohol wear off, the negative emotions associated with withdrawal can intensify PTSD symptoms.
Women are more likely than men to report symptoms of AUD and experience traumatic events, particularly domestic violence, sexual abuse, and sexual assault. Women with PTSD are more likely to use alcohol after a traumatic experience, while men are more likely to use other substances.
The link between PTSD and AUD can be understood through the self-medication hypothesis. Alcohol may temporarily relieve PTSD symptoms, but it can also worsen them in the long run. As alcohol alters the brain and central nervous system, it impairs the ability to cope with anxiety, depression, and other symptoms properly. This can create a cycle of self-medication, leading to alcohol dependence.
Treating PTSD and AUD simultaneously is crucial for effective recovery. Co-occurring treatment improves outcomes and enhances overall lifestyle. Social support is one of the greatest predictors of positive treatment outcomes. It is important to provide loved ones struggling with PTSD and AUD with care and compassion to motivate them to seek treatment.
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Self-medication hypothesis
The self-medication hypothesis is a theory that attempts to explain the relationship between post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD). It has been the predominant model to explain the comorbidity of the two disorders. The hypothesis suggests that individuals with PTSD use alcohol and other substances to numb their symptoms and later develop AUD or substance use disorder (SUD). This theory was proposed by Khantzian to explain the behaviour of individuals with AUD and SUD who were being treated in a clinical setting.
The self-medication hypothesis has been supported by laboratory studies that showed individuals with AUD and PTSD reported increased cravings for alcohol after being presented with a trauma stimulus compared to a neutral stimulus. However, other studies have found inconsistent results, with one showing that higher levels of PTSD symptoms predicted lower levels of next-day alcohol use. Furthermore, some research has shown that traumatic experiences may confer a type of survivor resilience that protects against the development of AUD. For example, studies of survivors of the Oklahoma City bombing in 1995 and a mass shooting in 1991 found no new cases of AUD reported after the events, and an overall decrease in alcohol misuse.
The self-medication hypothesis has been widely accepted in the literature examining alcohol use and anxiety. However, it lacks rigorous empirical support due to inconsistencies and methodological limitations, particularly the failure to operationalize drinking as a way to cope with trauma symptoms specifically. For instance, a review of 24 studies found only one that showed drinking to cope with negative affect predicted alcohol consumption one week after the 9/11 terror attacks, but not 16 weeks after.
Despite the lack of empirical support, the self-medication hypothesis remains influential in understanding the relationship between PTSD and AUD. The treatment of comorbid AUD is considered vital for the effective management of PTSD, but there is a dearth of evidence on how to treat the two disorders when they co-occur. Ongoing research is focused on identifying medication treatments that can improve outcomes for patients with both disorders.
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Alcohol as a coping mechanism
Alcohol is a commonly used coping mechanism for PTSD. Research has shown that individuals with post-traumatic stress disorder (PTSD) use alcohol and experience alcohol use disorder (AUD) to a greater degree than those without PTSD. This link between PTSD and AUD was first observed in Vietnam War veterans but has since been broadened to include veterans of other wars and anyone exposed to trauma.
PTSD is a mental health condition that can occur in people after experiencing a major traumatic event. Symptoms of PTSD include feelings of helplessness, aggression, depression, anxiety, and even suicidal thoughts. People with PTSD may also experience hallucinations, nightmares, and flashbacks. To cope with these difficult symptoms, many turn to alcohol. Alcohol may provide temporary relief from intrusive thoughts, but as the effects of alcohol wear off, the negative emotions associated with withdrawal can intensify PTSD symptoms. This can create a cycle of self-medication, where the individual repeatedly uses alcohol to cope with their PTSD symptoms, leading to alcohol dependence.
Several factors can contribute to the use of alcohol as a coping mechanism for PTSD. Firstly, alcohol can be seen as a way to avoid thinking about traumatic events or experiencing emotions related to trauma. Secondly, individuals with PTSD may be more likely to develop alcoholism when trying to self-medicate their symptoms. This is supported by the self-medication hypothesis, which suggests that individuals with PTSD may turn to alcohol to alleviate their symptoms. Additionally, certain stressors can make it easier to use alcohol as a coping mechanism. For example, service members may fear that displaying PTSD symptoms will lead to their removal from the military, and in some military bases, alcohol misuse is more acceptable.
The relationship between PTSD and AUD is complex and bidirectional. While alcohol may temporarily relieve PTSD symptoms, it can ultimately worsen them and increase the frequency of episodes. This is because alcohol alters the brain and central nervous system, impairing the ability to cope with anxiety, depression, and other symptoms effectively. As a result, individuals may feel compelled to increase their alcohol consumption, further entrenching the cycle of alcohol dependence and exacerbating the challenges associated with PTSD.
It is important to recognize that alcohol is not an effective long-term solution for managing PTSD symptoms. While it may provide temporary relief, the negative consequences and potential for alcohol dependence can significantly outweigh any perceived benefits. Seeking professional help and exploring alternative coping strategies, such as therapy or support groups, is crucial for effectively managing PTSD and reducing the reliance on alcohol as a coping mechanism.
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Alcohol's effect on PTSD symptoms
Alcohol's effects on PTSD symptoms are complex and multifaceted. Research has shown that individuals with post-traumatic stress disorder (PTSD) often experience alcohol use disorder (AUD) to a greater degree than those without PTSD. This co-occurrence of PTSD and AUD has been observed across different populations, including veterans and civilians exposed to trauma. The relationship between the two disorders can be understood through several mechanisms:
Self-Medication and Coping
One of the primary reasons individuals with PTSD turn to alcohol is self-medication. The desire to avoid thinking about traumatic events or experiencing associated emotions can lead people with PTSD to drink alcohol. Alcohol may provide temporary relief from intrusive thoughts and feelings of helplessness, aggression, depression, anxiety, and even suicidal thoughts that often accompany PTSD. However, as the effects of alcohol wear off, withdrawal symptoms can intensify PTSD symptoms. This cycle of self-medication can lead to increased alcohol consumption over time. Additionally, alcohol abuse can increase the risk of further traumatic experiences due to the involvement of high-risk situations.
Neurobiological Effects
Alcohol also affects PTSD symptoms by altering brain function and the central nervous system. The changes induced by alcohol consumption can interfere with the brain's ability to respond appropriately to anxiety, depression, and other symptoms associated with PTSD. This alteration in brain function may contribute to the worsening of PTSD symptoms in intensity and frequency over time.
Social and Environmental Factors
Social and environmental factors can also play a role in the relationship between alcohol and PTSD symptoms. For veterans, the fear of being removed from the military due to PTSD symptoms may contribute to alcohol misuse, especially in environments where alcohol use is more acceptable. Additionally, stressors such as separation from family, leaving work, and financial problems can make it easier for individuals with PTSD to turn to alcohol as a coping mechanism.
Comorbidity and Diagnosis
The relationship between PTSD and AUD is complex, and the comorbidity between the two disorders has been well-established. In diagnostic criteria, such as the DSM-III-R and DSM-IV, PTSD was defined by experiencing a qualifying traumatic event and three other clusters of symptoms: re-experiencing the event, emotional numbing and avoidance, and hyperarousal. The definition has evolved, and in the DSM-5, PTSD is classified as a trauma- and stressor-related disorder. The diagnostic criteria for both PTSD and AUD require the presence of certain prerequisite conditions, such as a traumatic event or alcohol use, further highlighting the interconnectedness of the two disorders.
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Treatment options for co-occurring disorders
Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) are highly prevalent and debilitating psychiatric conditions that often co-occur. The presence of both disorders is one of the most common co-occurring disorders, with an estimated 44.6% of individuals with lifetime PTSD also meeting the criteria for AUD.
The co-occurrence of these disorders can lead to heightened risk for other psychiatric problems such as depression and anxiety, impaired vocational and social functioning, and poor treatment outcomes. Therefore, it is crucial to seek integrated treatment that addresses both conditions simultaneously.
- Psychotherapy: Trauma-focused cognitive behavioural therapies such as Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR) therapy are recommended for individuals with co-occurring PTSD and AUD. These therapies help individuals process traumatic memories and reduce the severity of PTSD symptoms.
- Medication: While research on medications to treat both disorders simultaneously is limited, some options exist. Topiramate, typically used to decrease drinking behaviour in AUD, and prazosin, an antihypertensive medication sometimes used to manage PTSD symptoms, may help reduce symptoms of both disorders. Additionally, antidepressants known as selective serotonin reuptake inhibitors (SSRIs) can be considered for treating PTSD.
- Evidence-based behavioural interventions: For AUD, these include relapse prevention, contingency management, motivational enhancement, couples therapy, 12-step facilitation, community reinforcement, and mindfulness practices. PTSD interventions include narrative exposure therapy, present-centred therapy, and EMDR.
- Dual Diagnosis Treatment: Due to the bi-directional nature of PTSD and AUD, a dual diagnosis and treatment approach may be necessary. This involves receiving a comprehensive assessment to determine the intensity and types of treatments required, followed by an individualized treatment plan that addresses both disorders and their interactions.
- Veteran-specific Resources: For military personnel and veterans struggling with co-occurring PTSD and AUD, specialized treatment options are available. The U.S. Department of Veterans Affairs and organizations like American Addiction Centers (AAC) offer programming tailored to the unique challenges faced by veterans and their families.
- Support Systems: Seeking support from family, friends, and loved ones can be a crucial aspect of treatment and recovery. Additionally, accepting one's feelings following a traumatic event and developing healthy coping mechanisms can help reduce the impact of PTSD and AUD.
It is important to note that treatment should be tailored to the individual's unique circumstances and goals. Integrated treatment for co-occurring PTSD and AUD can be challenging, and seeking professional help is essential for long-lasting recovery.
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Frequently asked questions
Alcohol is often used as a coping mechanism to deal with the symptoms of PTSD, such as feelings of helplessness, aggression, depression, anxiety, and even suicidal thoughts.
Alcohol may provide temporary relief from intrusive thoughts, but as the effects of alcohol wear off, the negative emotions associated with withdrawal can intensify PTSD symptoms. Alcohol abuse is also related to involvement in high-risk situations, which may lead to further traumatic experiences.
Alcohol alters the brain and central nervous system, preventing proper responses to coping with anxiety, depression, and other symptoms. This may cause an increase in the amount of alcohol consumed, creating a cycle of self-medication.
Yes, women are more likely than men to experience a traumatic event and develop PTSD. Women with PTSD are also more likely to use alcohol after trauma, whereas men are more likely to use other substances.
Yes, veterans have higher rates of PTSD and alcohol use disorder compared to the general population. The number of veterans seeking treatment for co-occurring PTSD and substance use disorder has increased by at least 300% in recent years.
